CLINICAL-EXPERIENCE WITH THE PECTORAL ICD IMPLANTATION

The pectoral approach to implantation of cardioverter/defibrillators h as the aim to further simplify the implantation of transvenous defibri llation systems. The PCD(R) 7219 D/C is a device of the fourth generat ion which makes the pectoral implantation feasible due to a weight of 132 g, a size of 89 x 64 x 18 mm, a volume of 83 cm(3) and a surface o f 108 cm(2). The use of the ''active-can''-system (PCD(R) 7219 C) requ ires the implantation of only one right ventricular lead. The PCD(R) 7 219 D/C was implanted in 75 patients with ventricular tachyarrhythmias , the follow-up period was 12 +/- 4 (1-24) months. Subpectoral implant ation was feasible in 59 patients (79%), in 55 with a left pectoral, i n 4 with a right pectoral approach due to previous left-sided operatio n or thrombosis of the left subclavian vein. Male sex (p < 0.005), bod y weight (p < 0.005) and body surface (p < 0.05) were predictors of pe ctoral implantation. In the 45 patients (60%) with a unipolar defibril lation system (''active can'') the defibrillation threshold was signif icantly lower compared to those with a dual lead system (9.9 +/- 6.5, 2.5-24 Joule vs. 19 +/- 4.5, 6-24 Joule, p < 0.0001). In one patient w ith pectoral and in one patient with abdominal implantation a dislodge ment of the right ventricular lead was diagnosed and an operative revi sion was indicated. Conclusion: The down-sized implantable cardioverte r/defibrillator PCD(R) 7219 D/C makes the pectoral implantation feasib le in the majority of patients. The use of the ''active-can''-system r equires the implantation of only one right ventricular lead with signi ficantly lower defibrillation thresholds.